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Effect of parental anxiety and catastrophizing on post-tonsillectomy opioid consumption in children
Tanya Chen1, Jennifer M Siu1, Bradley Hubbard2
1Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Insights
Parental anxiety and pain catastrophizing correlate with increased early opioid use in children after tonsillectomy. Targeted parental mental health screening and counseling can improve pediatric pain management.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Psychological Factors in Health
Background:
- Parental psychological factors significantly influence pediatric post-operative pain management, though this relationship is not fully understood.
- Understanding these factors is crucial for optimizing pain control in children undergoing surgical procedures.
Purpose of the Study:
- To investigate the association between parental anxiety, pain catastrophizing, and opioid administration in children undergoing tonsillectomy.
- To identify psychological predictors of early post-operative opioid use in pediatric patients.
Main Methods:
- A multicenter prospective cohort study involving parents of children undergoing adenotonsillectomy.
- Parental anxiety and pain catastrophizing were assessed using the State-Trait Anxiety Inventory (STAI), Numeric Anxiety Scale (NAS), and Pain Catastrophizing Scale-Parent Version (PCS-P).
- Post-operative opioid analgesia data was collected on post-operative days 1, 3, 7, and 10.
Main Results:
- Higher parental scores on the PCS-P and NAS were linked to increased odds of early post-operative opioid administration (POD 1 and 3).
- Children with communication delays and younger children also showed increased early opioid administration.
- The study included 236 patients, with a mean child age of 5.1 years.
Conclusions:
- Elevated parental anxiety and catastrophizing tendencies predict higher early opioid administration in children post-tonsillectomy.
- Children with communication difficulties require more opioid analgesia.
- Interventions focusing on parental mental health screening, peri-operative counseling, and tailored pain management programs are recommended.
Background:
The impact of parental psychological factors on post-operative pain management in children is not well understood, but is important. The aim of this study was to determine the relationship between parental anxiety, pain catastrophizing about child pain, and opioid administration in children undergoing tonsillectomy.
Methods:
This was a multicenter prospective cohort study from four different centers between 2022 and 2023. All parents of children undergoing adenotonsillectomy were included. Parental levels of anxiety and pain catastrophizing were assessed using the State-Trait Anxiety inventory (STAI), a Numeric Anxiety Scale (NAS), and the Pain Catastrophizing Scale-Parent Version (PCS-P). Post-operative analgesia data was collected on post-operative days (POD) 1, 3, 7, and 10.
Results:
236 patients were included. Mean child age was 5.1 years old (SD 2.8). Mean baseline parental PCS-P score was 34.4 and NAS was 6.1. Higher PCS-P and NAS scores corresponded to increased odds of opioid administration in the early postoperative period (POD 1 and 3 [aOR 1.16, 95 % CI [1.03-2.99])). Children with a communication delay (aOR 4.75, 95 % CI [2.35-9.59]) and young children (aOR 1.73, 95 % CI [1.45-2.56]) also had increased opioid administration in the early postoperative period (POD1 & 3).
Conclusion:
Parents who have higher anxiety and tendencies to catastrophize are more likely to administer opioids early in the postoperative period. Children with limited communication skills are more likely to receive greater amounts of opioids after tonsillectomy. Interventions such as targeted screening for parental mental health, peri-operative counseling, and tailored pain control programs represent promising avenues for improving pain management.
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